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Many of us probably think of the randomised controlled trial (RCT) as a largely British invention dating from shortly after the second world war, but an interesting short paper in the NEJM shows that its antecedents go back much further (The Emergence of the Randomized, Controlled Trial: Laura E. Bothwell, Ph.D., and Scott H. Podolsky, M.D. N Engl J Med 2016; 375:501-504 August 11, 2016 DOI: 10.1056/NEJMp1604635).

RCTs thus represent the most recent outgrowth of a long history of attempts to adjudicate therapeutic efficacy. Their immediate ancestor, alternate-allocation trials, emerged as part of a trend toward empiricism and systematization in medicine and in response to the need for more rigorous assessment of a rapidly expanding array of experimental treatments. Alternate allocation represented a significant advancement for addressing clinical research bias -- but one that had limitations as long as it allowed foreknowledge of treatment allocation. Concealed random allocation merged as the solution to these limitations, and RCTs were soon supported by crucial public funding and scientific regulatory infrastructures.